Hypoglycemia causes: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
 
(82 intermediate revisions by 9 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Hypoglycemia}}
{{Hypoglycemia}}
{{CMG}}
{{CMG}} {{AE}} {{CLG}} {{MAD}}


== Causes ==
== Overview ==
===Common Causes===
Causes of hypoglycemia depend on age; neonatal causes are transient neonatal hypoglycemia, [[Prematurity]], [[intrauterine growth retardation]], [[perinatal asphyxia]], [[Sepsis|sepsis,]] congenital [[hypopituitarism]], beta sympathomimetic drugs[[Congenital hyperinsulinism|, congenital hyperinsulinism]], [[Infant of diabetic mother (patient information)|infant of a diabetic mother]][[Beckwith-Wiedemann syndrome|, Beckwith-Wiedemann syndrome]] and [[Inborn error of metabolism|inborn errors of carbohydrate metabolism]]. Causes of adult hypoglycemia are: [[insulin]] or insulin secretagogue drugs, [[alcohol]], [[hepatic failure]], [[Renal insufficiency|renal failure]], [[cardiac failure]], [[sepsis]], non-islet cell [[Pancreatic cancer|pancreatic tumors]], [[insulinoma]], reactive hypoglycemia, post [[Gastric bypass surgery|gastric bypass]] hypoglycemia, and [[Autoimmune|autoimmune]]<nowiki/>e hypoglycemia.  
==== Hypoglycemia in Newborn Infants ====
== Causes of hypoglycemia ==
Hypoglycemia is a common problem in critically ill or extremely [[low birthweight infants]]. If not due to maternal hyperglycemia, in most cases it is multifactorial, transient and easily supported. In a minority of cases hypoglycemia turns out to be due to significant [[hyperinsulinism]], [[hypopituitarism]] or an [[inborn error of metabolism]] and presents more of a management challenge.
=== Hypoglycemia in Newborn Infants ===
*Transient neonatal hypoglycemia
*Transient neonatal hypoglycemia:
**[[Prematurity]], [[intrauterine growth retardation]], [[perinatal asphyxia]]
**[[Blood glucose]] level in healthy newborns falls due to loss of the mothers' [[glucose]] supply that passes the [[placenta]].<ref name="pmid25819173">{{cite journal| author=Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW et al.| title=Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management. | journal=J Pediatr | year= 2015 | volume= 166 | issue= 6 | pages= 1520-5.e1 | pmid=25819173 | doi=10.1016/j.jpeds.2015.02.045 | pmc=4659381 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25819173  }}</ref> [[Plasma glucose]] level is corrected by [[glycogenolysis]] and [[gluconeogenesis]].<ref name="pmid10202173">{{cite journal| author=Stanley CA, Baker L| title=The causes of neonatal hypoglycemia. | journal=N Engl J Med | year= 1999 | volume= 340 | issue= 15 | pages= 1200-1 | pmid=10202173 | doi=10.1056/NEJM199904153401510 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10202173  }}</ref>
**Maternal hyperglycemia due to [[diabetes]] or iatrogenic glucose administration
**[[Sepsis]]
**Prolonged fasting (e.g., due to inadequate breast milk or condition interfering with feeding)
*Congenital hypopituitarism
*[[Congenital hyperinsulinism]], several types, both transient and persistent
*[[Inborn error of metabolism|Inborn errors of carbohydrate metabolism]] such as [[glycogen storage disease]]
 
====Hypoglycemia in Young Children====
Single episodes of hypoglycemia due to [[gastroenteritis]] or fasting, but recurrent episodes nearly always indicate either an [[inborn error of metabolism]], congenital hypopituitarism, or congenital hyperinsulinism
*Prolonged fasting
**[[Diarrhea]]l illness in young children, especially [[rotavirus]] [[gastroenteritis]]
*Idiopathic [[ketotic hypoglycemia]]
*Isolated [[growth hormone deficiency]], [[hypopituitarism]]
*[[Hyperinsulinemic hypoglycemia|Insulin excess]]
**Hyperinsulinism due to several [[congenital hyperinsulinism|congenital disorders of insulin secretion]]
**Insulin injected for type 1 diabetes
*[[Gastric dumping syndrome]] (after gastrointestinal surgery)
*Other congenital metabolic diseases; some of the common include
**[[Maple syrup urine disease]] and other [[organic aciduria]]s
**[[Glycogen storage disease|Type 1 glycogen storage disease]]
**Disorders of fatty acid oxidation
**[[Medium chain acylCoA dehydrogenase deficiency]] ([[MCAD]])
*Accidental ingestions
**[[Sulfonylurea]]s, [[propranolol]] and others
**[[Ethanol]] (mouthwash, "leftover morning-after-the-party drinks")
 
====Hypoglycemia in Older Children and Young Adults====
By far the most common cause of severe hypoglycemia in this age range is insulin injected for [[type I diabetes|type 1 diabetes]]. Circumstances should provide clues fairly quickly for the new diseases causing severe hypoglycemia. All of the congenital metabolic defects, congenital forms of [[hyperinsulinism]], and congenital hypopituitarism are likely to have already been diagnosed or are unlikely to start causing new hypoglycemia at this age. [[Body mass]] is large enough to make starvation hypoglycemia and idiopathic [[ketotic hypoglycemia]] quite uncommon. Recurrent mild hypoglycemia may fit a [[reactive hypoglycemia]] pattern, but this is also the peak age for [[idiopathic postprandial syndrome]], and recurrent "spells" in this age group can be traced to [[orthostatic hypotension]] or [[hyperventilation]] as often as demonstrable hypoglycemia.
*Insulin-induced hypoglycemia
**Insulin injected for type 1 diabetes
**Factitious insulin injection ([[Munchausen syndrome]])
**[[Insulin-secreting pancreatic tumor]]
**[[Reactive hypoglycemia]] and [[idiopathic postprandial syndrome]]
*[[Addison's disease]]
*[[Sepsis]]
 
====Hypoglycemia in Older Adults====
The incidence of hypoglycemia due to complex drug interactions, especially involving oral hypoglycemic agents and insulin for diabetes rises with age. Though much rarer, the incidence of insulin-producing tumors also rises with advancing age. Most tumors causing hypoglycemia by mechanisms other than insulin excess occur in adults.
*Insulin-induced hypoglycemia
**Insulin injected for diabetes
**Factitious insulin injection ([[Munchausen syndrome]])
**Excessive effects of oral diabetes drugs, [[beta-blockers]], or drug interactions
**[[Insulin-secreting pancreatic tumor]]
**Alimentary (rapid jejunal emptying with exaggerated insulin response)
***After gastrectomy [[dumping syndrome]] or bowel bypass surgery or resection
**[[Reactive hypoglycemia]] and [[idiopathic postprandial syndrome]]
*[[Causes of hypoglycemia#Extrapancreatic Tumors|Tumor hypoglycemia]], Doege-Potter syndrome
*Acquired [[adrenal insufficiency]]
*Acquired [[hypopituitarism]]
*Immunopathologic hypoglycemia <ref name=health.am>{{cite web | Umesh Masharani, MB, BS, MRCP(UK) | title =The Hypoglycemic states - Hypoglycemia |
publisher=Armenian Medical Network | work =The Hypoglycemic states |
url=http://www.health.am/db/the-hypoglycemic-states-hypoglycemia/ | year = 2007 }}</ref>
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[1,1-Dichloroethene]], [[Ackee fruit ]], [[Jamaican vomiting sickness]], [[Systemic monochloroacetate poisoning]],[[Ethanol]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetohexamide]], [[Acetaminophen and Oxycodone]], [[Amprenavir]], [[Chloramphenicol]], [[Chlorpromazine]], [[Chlorpropamide]], [[Cibenzoline]], [[Clove]], [[Ethanol]], [[Ethionamide]], [[Fluorodeoxyglucose]], [[Gatifloxacin]], [[Ginseng]], [[Glibenclamide]], [[Gliclazide]], [[Glimepiride]], [[Glipizide]], [[Gliquidone]], [[Glisolamide]], [[Glisoxepide]], [[Glyburide]], [[Glyburide and Metformin]], [[Insulin aspart]], [[Insulin detemir]], [[Insulin glargine]], [[Insulin like growth factor ]], [[Lanreotide]], [[Levomepromazine]], [[Linagliptin]], [[Mitiglinide]], [[Nateglinide]], [[Oxcarbazepine]], [[Pazopanib]], [[Pentamidine Isethionate]], [[Perazine]], [[Pipothiazine]], [[Pramipexole]], [[Pramlintide]], [[Quinine]], [[Repaglinide]], [[Repaglinide and Metformin hydrochloride]], [[Rifaximin]], [[Ritonavir]], [[Saxagliptin]], [[Saquinavir]], [[Sertraline]], [[Somatostatin]], [[Sulfamethoxazole]], [[Temafloxacin]], [[Thalidomide]], [[Tolazamide]], [[Tolbutamide]], [[Trimethoprim]],[[Reye syndrome]], [[Zonisamide]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Addison's disease]], [[Adrenal cortex insufficiency]], [[Adrenal insufficiency]], [[Beginning stages of diabetes]], [[Glucagon deficiency]], [[Hypopituitarism]], [[Hypothyroidism]], [[Multiple endocrine neoplasia ]], [[Myxedema coma]], [[Timme syndrome]], [[Familial glucocorticoid deficiency]]
 
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute fatty liver of pregnancy]], [[Acute liver failure]], [[Cirrhosis]], [[Diabetic gastroparesis]], [[Diarrhea]], [[Dumping syndrome]], [[Functioning pancreatic endocrine tumor]], [[Gastric dumping syndrome]], [[Hepatic congestion]], [[Hepatic failure]], [[Idiopathic postprandial syndrome]], [[Insulinoma]], [[Liver cancer]], [[Malabsorption]], [[Maldigestion]], [[Reactive hypoglycemia]], [[Severe hepatitis]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[2-methylbutyryl-coenzyme A dehydrogenase deficiency]], [[3-alpha-hydroxyacyl-CoA dehydrogenase deficiency]], [[3-Methylcrotonyl-CoA carboxylase deficiency]], [[ACAD9 deficiency]], [[Alpers Syndrome]], [[Carbohydrate-deficient glycoprotein syndrome type 1b]], [[Carnitine palmitoyltransferase 1 deficiency]], [[Carnitine-acylcarnitine translocase deficiency]], [[Cleft lip palate pituitary deficiency]], [[Dicarboxylicaminoaciduria]], [[Dihydrolipoamide dehydrogenase deficiency]], [[Donohue syndrome]], [[Dopamine beta-hydroxylase deficiency]], [[Familial glucocorticoid deficiency]], [[Familial hyperinsulinemic hypoglycemia type 3]], [[Familial hyperinsulinemic hypoglycemia type 5]], [[Familial hyperinsulinemic hypoglycemia type 7]], [[Fructose-1, 6-diphosphatase deficiency]], [[Fructose-1-phosphate aldolase deficiency]], [[Galactose-1-phosphate uridyltransferase deficiency]], [[Glucose 6 phosphate dehydrogenase deficiency]], [[Glutaric acidemia type 2]], [[Glycogenosis type 1a]], [[Glycogenosis type 1b]], [[Glycogenosis type 3]], [[Glycogenosis type 6]], [[Glycogenosis type 9a]], [[Glycogenosis type 9b]], [[Glycogenosis type 9c]], [[Glycogenosis type V]], [[Growth hormone deficiency (congenital)]], [[Hereditary ACTH resistance]], [[HMG-CoA lyase deficiency]], [[Hydroxymethylglutaryl-CoA lyase deficiency]], [[Hyperinsulinism-hyperammonemia syndrome]], [[Laron dwarfism]], [[Leucine-induced hypoglycaemia]], [[Liver glycogen synthase deficiency]], [[Long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[Malonyl-CoA decarboxylase deficiency]], [[Maple syrup urine disease]], [[Medium chain acyl-CoA dehydrogenase deficiency]], [[Methylmalonic acidemia]], [[Mitochondrial DNA depletion syndrome, hepatocerebral form]], [[Mitochondrial trifunctional protein deficiency]], [[Navajo neurohepatopathy]], [[Nephroblastomatosis-fetal ascites-macrosomia-wilms tumor]], [[Nesidioblastosis]], [[Plasma membrane carnitine transporter deficiency]], [[Propionyl-CoA carboxylase deficiency PCCA type]], [[Short chain acyl-CoA dehydrogenase deficiency]], [[Short stature-pituitary and cerebellar defects-small sella turcica]], [[Triple A syndrome]], [[Tyrosinaemia type 1]], [[Very long-chain acyl-CoA dehydrogenase deficiency]], [[Wiedemann-Beckwith syndrome]], [[X-linked congenital adrenal hypoplasia ]], [[Septic shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Hemolytic disease of the newborn]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Gastrojejunostomy]], [[Postgastrectomy syndrome]], [[Pyloroplasty]], [[Reye syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute meningitis]], [[Malaria (malignant tertian)]], [[Sepsis]], [[Visceral leishmaniasis]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Autonomic dystonia]], [[Autonomic neuropathy]], [[Elevated vagal tone]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Coenzyme Q cytochrome c reductase deficiency]], [[Deficiency in enzymes of fat oxidation]], [[Fructose intolerance]], [[Galactosemia]], [[Glycogen debranching deficiency]], [[Hypoketonemic hypoglycemia]], [[Ketotic hypoglycemia of infancy]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[Organic acidemia]], [[Phosphoenolpyruvate carboxykinase (PEPCK) deficiency]], [[Urea cycle disorder]], [[Glucagon deficiency]], [[ACAD9 deficiency]], [[Dicarboxylicaminoaciduria]], [[Fructose-1, 6-diphosphatase deficiency]], [[Fructose-1-phosphate aldolase deficiency]], [[Glucose 6 phosphate dehydrogenase deficiency]], [[Glutaric acidemia type 2]], [[Glycogenosis type 1a]], [[Glycogenosis type 1b]], [[Glycogenosis type 3]], [[Glycogenosis type 6]], [[Glycogenosis type 9a]], [[Glycogenosis type 9b]], [[Glycogenosis type 9c]], [[Glycogenosis type V]], [[HMG-CoA lyase deficiency]], [[Hydroxymethylglutaryl-CoA lyase deficiency]], [[Long chain hydroxyacyl-CoA dehydrogenase deficiency]], [[Malonyl-CoA decarboxylase deficiency]], [[Maple syrup urine disease]], [[Medium chain acyl-CoA dehydrogenase deficiency]], [[Methylmalonic acidemia]], [[Nesidioblastosis]], [[Propionyl-CoA carboxylase deficiency PCCA type]], [[Short chain acyl-CoA dehydrogenase deficiency]], [[Tyrosinaemia type 1]], [[Very long-chain acyl-CoA dehydrogenase deficiency]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Diabetic mother]], [[Gestational diabetes]], [[Intrauterine growth retardation]], [[Pregnancy]], [[Premature labour and/or delivery]], [[Sheehan syndrome]], [[Acute fatty liver of pregnancy]],[[Hemolytic disease of the newborn]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Adrenal cancer]], [[Doege-Potter syndrome]], [[IGF producing tumors]], [[Tumors]], [[Functioning pancreatic endocrine tumor]], [[Insulinoma]], [[Liver cancer]], [[Mesothelioma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| [[Acetohexamide]], [[Amprenavir]], [[Chloramphenicol]], [[Chlorpromazine]], [[Chlorpropamide]], [[Cibenzoline]], [[Clove]], [[Ethanol]], [[Ethionamide]], [[Fluorodeoxyglucose]], [[Gatifloxacin]], [[Ginseng]], [[Glibenclamide]], [[Gliclazide]], [[Glimepiride]], [[Glipizide]], [[Gliquidone]], [[Glisolamide]], [[Glisoxepide]], [[Insulin]], [[Insulin like growth factor ]], [[Lanreotide]], [[Levomepromazine]], [[Mitiglinide]], [[Nateglinide]], [[Pazopanib]], [[Pentamidine]], [[Perazine]], [[Pipothiazine]], [[Pramlintide]], [[Quinine]], [[Repaglinide]], [[Ritonavir]], [[Saquinavir]], [[Somatostatin]], [[Sulfamethoxazole]], [[Temafloxacin]], [[Tolazamide]], [[Tolbutamide]], [[Trimethoprim]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Anorexia nervosa]], [[Bullimia nervosa]], [[Munchausen syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Mesothelioma]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Benign glucosuria]], [[Renal Failure]], [[Renal hypoglycemia]], [[Uremia ]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Autoimmune adrenalitis]], [[Hemolytic disease of the newborn]], [[Immunopathologic hypoglycemia]], [[Insulin receptor antibodies]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Burns]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Alcoholism]], [[Binge drinking]], [[Cachexia]], [[Delayed separation blood sample]], [[Drip arm sample]], [[Fasting ]], [[Heavy exercise]], [[Hypothermia]], [[Idiopathic hypoglycemia]], [[Starvation (acute)]], [[Mcquarrie type infantile idiopathic hypoglycemia]], [[Burns]], [[Ethanol]]
|-
|}
 
===Causes in Alphabetical Order===
 
{{MultiCol}}
*[[1,1-Dichloroethene]]
*[[2-methylbutyryl-coenzyme A dehydrogenase deficiency]]
*[[3-alpha-hydroxyacyl-CoA dehydrogenase deficiency]]
*[[3-Methylcrotonyl-CoA carboxylase deficiency]]
*[[ACAD9 deficiency]]
*[[Acetohexamide]]
*[[Ackee fruit ]]
*[[Acute fatty liver of pregnancy]]
*[[Acute liver failure]]
*[[Acute meningitis]]
*[[Addison's disease]]
*[[Adrenal cancer]]
*[[Adrenal cortex insufficiency]]
*[[Adrenal insufficiency]]
*[[Alcoholism]]
*[[Alpers Syndrome]]
*[[Amprenavir]]
*[[Anorexia nervosa]]
*[[Autoimmune adrenalitis]]
*[[Autonomic dystonia]]
*[[Autonomic neuropathy]]
*[[Beginning stages of diabetes]]
*[[Benign glucosuria]]
*[[Binge drinking]]
*[[Bullimia nervosa]]
*[[Burns]]
*[[Cachexia]]
*[[Carbohydrate-deficient glycoprotein syndrome type 1b]]
*[[Carnitine palmitoyltransferase 1 deficiency]]
*[[Carnitine-acylcarnitine translocase deficiency]]
*[[Chloramphenicol]]
*[[Chlorpromazine]]
*[[Chlorpropamide]]
*[[Cibenzoline]]
*[[Cirrhosis]]
*[[Cleft lip palate pituitary deficiency]]
*[[Clove]]
*[[Coenzyme Q cytochrome c reductase deficiency]]
*[[Deficiency in enzymes of fat oxidation]]
*[[Delayed separation blood sample]]
*[[Diabetic gastroparesis]]
*[[Diabetic mother]]
*[[Diarrhea]]
*[[Dicarboxylicaminoaciduria]]
*[[Dihydrolipoamide dehydrogenase deficiency]]
*[[Doege-Potter syndrome]]
*[[Donohue syndrome]]
*[[Dopamine beta-hydroxylase deficiency]]
*[[Drip arm sample]]
*[[Dumping syndrome]]
*[[Elevated vagal tone]]
*[[Ethanol]]
*[[Ethionamide]]
*[[Familial glucocorticoid deficiency]]
*[[Familial hyperinsulinemic hypoglycemia type 3]]
*[[Familial hyperinsulinemic hypoglycemia type 5]]
*[[Familial hyperinsulinemic hypoglycemia type 7]]
*[[Fasting ]]
*[[Fluorodeoxyglucose]]
*[[Fructose intolerance]]
*[[Fructose-1, 6-diphosphatase deficiency]]
*[[Fructose-1-phosphate aldolase deficiency]]
*[[Functioning pancreatic endocrine tumor]]
*[[Galactose-1-phosphate uridyltransferase deficiency]]
*[[Galactosemia]]
*[[Gastric dumping syndrome]]
*[[Gastrojejunostomy]]
*[[Gatifloxacin]]
*[[Gestational diabetes]]
*[[Ginseng]]
*[[Glibenclamide]]
*[[Gliclazide]]
*[[Glimepiride]]
*[[Glipizide]]
*[[Gliquidone]]
*[[Glisolamide]]
*[[Glisoxepide]]
*[[Glucagon deficiency]]
*[[Glucose 6 phosphate dehydrogenase deficiency]]
*[[Glutaric acidemia type 2]]
*[[Glycogen debranching deficiency]]
*[[Glycogenosis type 1a]]
*[[Glycogenosis type 1b]]
*[[Glycogenosis type 3]]
*[[Glycogenosis type 6]]
*[[Glycogenosis type 9a]]
*[[Glycogenosis type 9b]]
*[[Glycogenosis type 9c]]
*[[Glycogenosis type V]]
*[[Growth hormone deficiency (congenital)]]
*[[Heavy exercise]]
*[[Hemolytic disease of the newborn]]
{{ColBreak}}
*[[Hepatic congestion]]
*[[Hepatic failure]]
*[[Hereditary ACTH resistance]]
*[[HMG-CoA lyase deficiency]]
*[[Hydroxymethylglutaryl-CoA lyase deficiency]]
*[[Hyperinsulinism-hyperammonemia syndrome]]
*[[Hypoketonemic hypoglycemia]]
*[[Hypopituitarism]]
*[[Hypothermia]]
*[[Hypothyroidism]]
*[[Idiopathic hypoglycemia]]
*[[Idiopathic postprandial syndrome]]
*[[IGF producing tumors]]
*[[Immunopathologic hypoglycemia]]
*[[Insulin]]
*[[Insulin like growth factor ]]
*[[Insulin lispro]]
*[[Insulin receptor antibodies]]
*[[Insulinoma]]
*[[Intrauterine growth retardation]]
*[[Jamaican vomiting sickness]]
*[[Janumet]] ([[sitagliptin]] and [[metformin]])
*[[Ketotic hypoglycemia of infancy]]
*[[Lanreotide]]
*[[Laron dwarfism]]
*[[Leucine-induced hypoglycaemia]]
*[[Levomepromazine]]
*[[Liver cancer]]
*[[Liver glycogen synthase deficiency]]
*[[Long chain hydroxyacyl-CoA dehydrogenase deficiency]]
*[[Malabsorption]]
*[[Malaria (malignant tertian)]]
*[[Maldigestion]]
*[[Malonyl-CoA decarboxylase deficiency]]
*[[Maple syrup urine disease]]
*[[Mcquarrie type infantile idiopathic hypoglycemia]]
*[[Medium chain acyl-CoA dehydrogenase deficiency]]
*[[Mesothelioma]]
*[[Methylmalonic acidemia]]
*[[Mitiglinide]]
*[[Mitochondrial DNA depletion syndrome, hepatocerebral form]]
*[[Mitochondrial trifunctional protein deficiency]]
*[[Multiple endocrine neoplasia ]]
*[[Munchausen syndrome]]
*[[Myxedema coma]]
*[[Nateglinide]]
*[[Navajo neurohepatopathy]]
*[[Nephroblastomatosis-fetal ascites-macrosomia-wilms tumor]]
*[[Nesidioblastosis]]
*[[Organic acidemia]]
*[[Pazopanib]]
*[[Pentamidine]]
*[[Perazine]]
*[[Phosphoenolpyruvate carboxykinase (PEPCK) deficiency]]
*[[Pipothiazine]]
*[[Plasma membrane carnitine transporter deficiency]]
*[[Postgastrectomy syndrome]]
*[[Pramlintide]]
*[[Pregnancy]]
*[[Premature labour and/or delivery]]
*[[Propionyl-CoA carboxylase deficiency PCCA type]]
*[[Pyloroplasty]]
*[[Quinine]]
*[[Reactive hypoglycemia]]
*[[Renal Failure]]
*[[Renal hypoglycemia]]
*[[Repaglinide]]
*[[Reye syndrome]]
*[[Ritonavir]]
*[[Saquinavir]]
*[[Sepsis]]
*[[Septic shock]]
*[[Severe hepatitis]]
*[[Sheehan syndrome]]
*[[Short chain acyl-CoA dehydrogenase deficiency]]
*[[Short stature-pituitary and cerebellar defects-small sella turcica]]
*[[Somatostatin]]
*[[Starvation (acute)]]
*[[Sulfamethoxazole]]
*[[Systemic monochloroacetate poisoning]]
*[[Temafloxacin]]
*[[Timme syndrome]]
*[[Tolazamide]]
*[[Tolbutamide]]
*[[Trimethoprim]]
*[[Triple A syndrome]]
*[[Tumors]]
*[[Tyrosinaemia type 1]]
*[[Urea cycle disorder]]
*[[Uremia ]]
*[[Very long-chain acyl-CoA dehydrogenase deficiency]]
*[[Visceral leishmaniasis]]
*[[Wiedemann-Beckwith syndrome]]
*[[X-linked congenital adrenal hypoplasia ]]
{{EndMultiCol}}


* [[Prematurity]]
* [[Intrauterine growth retardation]]
* [[perinatal asphyxia]]
* Maternal hyperglycemia due to [[diabetes]] or iatrogenic glucose administration
* [[Sepsis]]
* Congenital [[Hypopituitarism|hypopituitarism:]]
** [[Cortisol]] and [[growth hormone]] regulate [[glucose]] level
* Maternal use of [[Beta agonist|beta-sympathomimetics]]
** Interrupts [[glycogenolysis]] by blocking [[Epinephrine|epinephrine']]<nowiki/>s effect.<ref name="pmid27577580">{{cite journal| author=Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A et al.| title=Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia. | journal=Pediatrics | year= 2016 | volume= 138 | issue= 3 | pages=  | pmid=27577580 | doi=10.1542/peds.2016-0731 | pmc=5005024 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27577580  }}</ref>
* [[Hypothermia|Hypothermic]] infants who have increased rates of glucose utilization and decreased glucose availability.
* Severe [[hepatic]] dysfunction
** Leads to impairment of both [[glycogenolysis]] and [[gluconeogenesis]].
*[[Congenital hyperinsulinism]]:<ref name="pmid23739646">{{cite journal| author=Buraczewska B, Kopacz K, Myśliwiec M| title=Hyperinsulinism as a common cause of hypoglycemia in children - pathogenesis, diagnosis and treatment. | journal=Pediatr Endocrinol Diabetes Metab | year= 2013 | volume= 19 | issue= 1 | pages= 24-8 | pmid=23739646 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23739646  }}</ref>
**[[Infant of diabetic mother (patient information)|Infant of a diabetic mothe]]<nowiki/>r is most commonly affected by hypoglycemia due to [[hyperinsulinism]]. Prolonged intrapartum [[hyperglycemia]] in [[fetus]] leads to [[Hypertrophy (medical)|hypertrophied]] and hyperfunctioning [[beta cells]] causing [[hyperinsulinism]]. It is transient and resolves two days after birth.
**[[Beckwith-Wiedemann syndrome]]
**[[Persistent hyperinsulinemic hypoglycemia of infancy]]: it is a mutation in genes encoding [[enzymes]] that control [[intracellular]] [[metabolic]] pathways of the [[pancreatic]] beta cell.
**Excess [[exogenous]] [[insulin]] given to newborns with [[hyperglycemia]] may result in hypoglycemia.<ref name="pmid19588439">{{cite journal| author=Sinclair JC, Bottino M, Cowett RM| title=Interventions for prevention of neonatal hyperglycemia in very low birth weight infants. | journal=Cochrane Database Syst Rev | year= 2009 | volume=  | issue= 3 | pages= CD007615 | pmid=19588439 | doi=10.1002/14651858.CD007615.pub2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19588439  }}</ref>
**Neonatal conditions associated with excessive [[insulin]] secretion include [[alloimmune]] [[Hemolytic disease of the newborn|hemolytic disease]] of the newborn, [[heart failure]] and [[sepsis]].<ref name="pmid10331464">{{cite journal| author=Sue CM, Hirano M, DiMauro S, De Vivo DC| title=Neonatal presentations of mitochondrial metabolic disorders. | journal=Semin Perinatol | year= 1999 | volume= 23 | issue= 2 | pages= 113-24 | pmid=10331464 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10331464  }}</ref>
**[[Polycythemia]] may lead to greater glucose utilization by the increased mass of red blood cells.
**[[Nesidioblastosis]]
*[[Inborn error of metabolism|Inborn errors of metabolism]]:<ref name="pmid9832597">{{cite journal| author=Burton BK| title=Inborn errors of metabolism in infancy: a guide to diagnosis. | journal=Pediatrics | year= 1998 | volume= 102 | issue= 6 | pages= E69 | pmid=9832597 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9832597  }}</ref>
**Disorders of [[gluconeogenesis]]: [[Fructose bisphosphatase deficiency|fructose-1,6-bisphosphatase]] deficiency, [[pyruvate carboxylase deficiency]].
**Disorders of [[carbohydrate metabolism]]: [[hereditary fructose intolerance]], [[Galactosemia|galactosemia.]]
**Disorders of [[Fatty acid metabolism|fatty acid metabolism:]] medium or [[Long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficiency|long-chain acyl-CoA dehydrogenase deficiency]]).<ref name="pmid7726385">{{cite journal| author=Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A et al.| title=Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism. | journal=Brain Dev | year= 1994 | volume= 16 Suppl | issue=  | pages= 81-5 | pmid=7726385 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7726385  }}</ref>
===Hypoglycemia in Adults===
* Drugs are the most common cause of hypoglycemia in adults.<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155  }}</ref> The most important causes of hypoglycemia in adults include:
**[[Insulin]] or insulin secretagogues such as [[sulfonylurea]] and glyburide are the most common drugs that may cause hypoglycemia due to longer duration of action<ref name="pmid16324923">{{cite journal| author=Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE et al.| title=Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia. | journal=Metabolism | year= 2006 | volume= 55 | issue= 1 | pages= 78-83 | pmid=16324923 | doi=10.1016/j.metabol.2005.07.009 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16324923  }}</ref>. They suppress hepatic [[glucose]] production and stimulate glucose utilization which may result in hypoglycemia.
**[[Quinolones]]
**[[Pentamidine]]
**[[Quinine]]
**[[Beta blockers]]
**[[Angiotensin-converting enzyme inhibitors]]
**[[Insulin-like growth factor-I|IGF-1]]
***Especially in older patients with underlying [[renal]] or [[hepatic]] dysfunction<ref name="pmid25179404">{{cite journal| author=Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS| title=Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas. | journal=JAMA Intern Med | year= 2014 | volume= 174 | issue= 10 | pages= 1605-12 | pmid=25179404 | doi=10.1001/jamainternmed.2014.3293 | pmc=4878670 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25179404  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25686188 Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13]</ref>
**[[Alcohol]]
***Due to [[hepatic]] [[glycogen]] depletion in fasting patients
***[[Alcohol]] can induce hypoglycemia alone or associated with other hypoglycemic drugs
* Critical illnesses:
** [[Hepatic failure]]
** [[Renal failure]]
** [[Congestive heart failure|Cardiac failure]]
** [[Sepsis]]
*** It occurs due to impaired liver [[gluconeogenesis]]
*** [[Sepsis]] induced [[cytokines]] secretion cause suppression of [[gluconeogenesis]]<ref name="pmid10807013">{{cite journal| author=Maitra SR, Wojnar MM, Lang CH| title=Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis. | journal=Shock | year= 2000 | volume= 13 | issue= 5 | pages= 379-85 | pmid=10807013 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10807013  }}</ref>
* [[Hormone]] deficiency: [[cortisol]] in acquired [[adrenal insufficiency|adrenal insufficiency or]] acquired [[hypopituitarism]]<ref name="pmid26563979">{{cite journal| author=Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W| title=Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life. | journal=Eur J Endocrinol | year= 2016 | volume= 174 | issue= 2 | pages= 177-86 | pmid=26563979 | doi=10.1530/EJE-15-0775 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26563979  }}</ref>
* [[Islet cell|Non islet cell]] [[tumor]]: hypoglycemia usually occurs as a result of [[tumor]] production of [[Insulin-like growth factor 2|IGF-2]]
* [[Insulinoma]]
* [[Reactive hypoglycemia]] or postprandial
** A hypoglycemia that occurs as a reaction to food ingestion within 4 hours after meals due to [[Hyperinsulinism|functional hyperinsulinism]]<ref name="pmid24246338">{{cite journal| author=Galati SJ, Rayfield EJ| title=Approach to the patient with postprandial hypoglycemia. | journal=Endocr Pract | year= 2014 | volume= 20 | issue= 4 | pages= 331-40 | pmid=24246338 | doi=10.4158/EP13132.RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24246338  }}</ref>
*[[Gastric bypass|Post gastric bypass]] hypoglycemia
**Rapid [[Jejunum|jejunal]] emptying with exaggerated [[insulin]] response
* [[Insulin]] [[autoimmune]] hypoglycemia
** Occurs in patients who have [[antibodies]] directed to endogenous [[insulin]] or to the [[insulin]] [[receptor]]<ref name="pmid19440117">{{cite journal| author=Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P| title=Autoimmune forms of hypoglycemia. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 3 | pages= 141-53 | pmid=19440117 | doi=10.1097/MD.0b013e3181a5b42e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19440117  }}</ref>
* Accidental, surreptitious, or malicious hypoglycemia
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Needs overview]]
[[Category:Endocrinology]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Medical emergencies]]
[[Category:Blood tests]]
[[Category:Metabolic disorders]]
[[Category:Disease]]
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}

Latest revision as of 19:03, 15 November 2017

Hypoglycemia Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Hypoglycemia from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Hypoglycemia causes On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Hypoglycemia causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Hypoglycemia causes

CDC on Hypoglycemia causes

Hypoglycemia causes in the news

Blogs on Hypoglycemia causes

Directions to Hospitals Treating Hypoglycemia

Risk calculators and risk factors for Hypoglycemia causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Carlos A Lopez, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview

Causes of hypoglycemia depend on age; neonatal causes are transient neonatal hypoglycemia, Prematurity, intrauterine growth retardation, perinatal asphyxia, sepsis, congenital hypopituitarism, beta sympathomimetic drugs, congenital hyperinsulinism, infant of a diabetic mother, Beckwith-Wiedemann syndrome and inborn errors of carbohydrate metabolism. Causes of adult hypoglycemia are: insulin or insulin secretagogue drugs, alcohol, hepatic failure, renal failure, cardiac failure, sepsis, non-islet cell pancreatic tumors, insulinoma, reactive hypoglycemia, post gastric bypass hypoglycemia, and autoimmunee hypoglycemia.

Causes of hypoglycemia

Hypoglycemia in Newborn Infants

Hypoglycemia in Adults

References

  1. ↑ Stanley CA, Rozance PJ, Thornton PS, De Leon DD, Harris D, Haymond MW; et al. (2015). "Re-evaluating "transitional neonatal hypoglycemia": mechanism and implications for management". J Pediatr. 166 (6): 1520–5.e1. doi:10.1016/j.jpeds.2015.02.045. PMC 4659381. PMID 25819173.
  2. ↑ Stanley CA, Baker L (1999). "The causes of neonatal hypoglycemia". N Engl J Med. 340 (15): 1200–1. doi:10.1056/NEJM199904153401510. PMID 10202173.
  3. ↑ Bateman BT, Patorno E, Desai RJ, Seely EW, Mogun H, Maeda A; et al. (2016). "Late Pregnancy β Blocker Exposure and Risks of Neonatal Hypoglycemia and Bradycardia". Pediatrics. 138 (3). doi:10.1542/peds.2016-0731. PMC 5005024. PMID 27577580.
  4. ↑ Buraczewska B, Kopacz K, Myśliwiec M (2013). "Hyperinsulinism as a common cause of hypoglycemia in children - pathogenesis, diagnosis and treatment". Pediatr Endocrinol Diabetes Metab. 19 (1): 24–8. PMID 23739646.
  5. ↑ Sinclair JC, Bottino M, Cowett RM (2009). "Interventions for prevention of neonatal hyperglycemia in very low birth weight infants". Cochrane Database Syst Rev (3): CD007615. doi:10.1002/14651858.CD007615.pub2. PMID 19588439.
  6. ↑ Sue CM, Hirano M, DiMauro S, De Vivo DC (1999). "Neonatal presentations of mitochondrial metabolic disorders". Semin Perinatol. 23 (2): 113–24. PMID 10331464.
  7. ↑ Burton BK (1998). "Inborn errors of metabolism in infancy: a guide to diagnosis". Pediatrics. 102 (6): E69. PMID 9832597.
  8. ↑ Worthen HG, al Ashwal A, Ozand PT, Garawi S, Rahbeeni Z, al Odaib A; et al. (1994). "Comparative frequency and severity of hypoglycemia in selected organic acidemias, branched chain amino acidemia, and disorders of fructose metabolism". Brain Dev. 16 Suppl: 81–5. PMID 7726385.
  9. ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.
  10. ↑ Szoke E, Gosmanov NR, Sinkin JC, Nihalani A, Fender AB, Cryer PE; et al. (2006). "Effects of glimepiride and glyburide on glucose counterregulation and recovery from hypoglycemia". Metabolism. 55 (1): 78–83. doi:10.1016/j.metabol.2005.07.009. PMID 16324923.
  11. ↑ Parekh TM, Raji M, Lin YL, Tan A, Kuo YF, Goodwin JS (2014). "Hypoglycemia after antimicrobial drug prescription for older patients using sulfonylureas". JAMA Intern Med. 174 (10): 1605–12. doi:10.1001/jamainternmed.2014.3293. PMC 4878670. PMID 25179404. Review in: Ann Intern Med. 2015 Feb 17;162(4):JC13
  12. ↑ Maitra SR, Wojnar MM, Lang CH (2000). "Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis". Shock. 13 (5): 379–85. PMID 10807013.
  13. ↑ Odenwald B, Nennstiel-Ratzel U, Dörr HG, Schmidt H, Wildner M, Bonfig W (2016). "Children with classic congenital adrenal hyperplasia experience salt loss and hypoglycemia: evaluation of adrenal crises during the first 6 years of life". Eur J Endocrinol. 174 (2): 177–86. doi:10.1530/EJE-15-0775. PMID 26563979.
  14. ↑ Galati SJ, Rayfield EJ (2014). "Approach to the patient with postprandial hypoglycemia". Endocr Pract. 20 (4): 331–40. doi:10.4158/EP13132.RA. PMID 24246338.
  15. ↑ Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P (2009). "Autoimmune forms of hypoglycemia". Medicine (Baltimore). 88 (3): 141–53. doi:10.1097/MD.0b013e3181a5b42e. PMID 19440117.
Retrieved from "https://www.wikidoc.org/index.php?title=Hypoglycemia_causes&oldid=1389241"